Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
DSH040017B NORTH ARKANSAS REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

NORTH ARKANSAS REGIONAL MEDICAL CENTER

Subdivision Name

MARSHALL FAMILY PRACTICE CLINIC

Type

Disproportionate Share Hospital

340B ID

DSH040017B

Entity Address

211 AIRPORT ROAD
MARSHALL, AR 72650

Medicare Provider Number

040017

Outpatient Facility Provider Number

Participating Start Date

10/1/2010

Last Recertification Date

8/15/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

CYSTIC FIBROSIS SERVICES, LLC

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033

Pharmacy Comments

Contract Details

Approval Date

10/12/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Sammie Cribbs, Chief Executive Officer
(870) 414-5159

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/12/2022

340B Drug Pricing Program Database